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Indeterminate orbital masses: restricted diffusion at MR imaging with echo-planar diffusion-weighted imaging predicts

Ali R Sepahdari1, Vinay K Aakalu, Pete Setabutr

  • 1Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Gray 273A, Boston, MA 02114, USA. andrea.klauser@i-med.ac.at

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|July 27, 2010
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Diffusion-weighted magnetic resonance (MR) imaging helps differentiate benign and malignant orbital masses. Optimal apparent diffusion coefficient (ADC) thresholds aid in distinguishing between these lesions, improving diagnostic accuracy.

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Area of Science:

  • Radiology
  • Oncology
  • Ophthalmology

Background:

  • Orbital masses present a diagnostic challenge, often requiring differentiation between benign and malignant conditions.
  • Magnetic resonance (MR) imaging, particularly diffusion-weighted (DW) imaging, offers potential for improved characterization of these lesions.

Purpose of the Study:

  • To evaluate the utility of DW MR imaging in discriminating between indeterminate benign and malignant orbital masses.
  • To establish optimal apparent diffusion coefficient (ADC) thresholds for differentiating these lesions.

Main Methods:

  • Retrospective analysis of 47 orbital masses in 47 patients using echo-planar DW MR imaging.
  • Calculation of ADC values for each lesion and comparison with normal white matter (ADC ratio).
  • Receiver operating characteristic analysis to determine optimal ADC thresholds for malignancy prediction.

Main Results:

  • Malignant orbital masses demonstrated significantly lower ADC values compared to benign lesions.
  • Optimal ADC thresholds of < 1.0 x 10(-3) mm(2)/sec and an ADC ratio of < 1.2 predicted malignancy with high specificity.
  • DW imaging accurately differentiated lymphoma from pseudotumor (100% accuracy).

Conclusions:

  • Echo-planar DW MR imaging is a valuable tool for characterizing indeterminate orbital masses.
  • Established ADC thresholds can aid in distinguishing benign from malignant orbital lesions, including lymphoma and pseudotumor.